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SUPPLEMENT to Web-App # <br /> , ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TAN 1411 ptt1AA) 4-- Wu,TC.v1/4 a;o LtzY LI Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> yo -Rti�tv\MILEY , PIT NoeCi , AZ 5357 Variance(# ) <br /> HOME pHopiE CELL PHONE E-MAIL ADDRESS <br /> (zit 7 4,-7 22.^ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SZ-NU CowsrR r'o w ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5/0 MR/N S, PO Box q5 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> O )ft) wr, 53577 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 601 - cla -2 67/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: F2_-i4 keREAG/E: ❑ Elevation of property <br /> ❑ NUM ER t�ii�-01's-4- 12D-O g SIDE iAr►- a��77 SQ frontage drawn to scale. <br /> TOWNSHIP: SECTION: `16 ibt <br /> WINDSOR.. /4: <br /> %I A: LI Driveway permits <br /> ADDRESS: (state,county,town) <br /> g Roo Kvit GS". Litt--72. F32cr N/1Ew CT ) ❑ Sanitary permits <br /> CSM: LOT •:c . - - • - <br /> g12 PA4■RN E + ' (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NG NooS` ❑ Zoning District <br /> . cif This project is a new building or structure. LI Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: t^cp. NUMBER OF STORIES: (Not including basement) <br /> aksj 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEM NT: 1ST FLOOR: ❑ ErosionControl permit <br /> g GO- ` -,(j 2- 4, TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> —3--,144 fllling/access) <br /> LI 4 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 1 / and available options. <br /> (Please round to nearest dollar) Jd /37 a , ,_ <br /> 3S3. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes NINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? V Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes `ANo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes rxiNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />